NPA Values Challenge: “We spend trillions of dollars on health care in this country — yet the allocation of those funds are grossly disproportionate to how other countries spend their health care expenditures. We aren’t focused on population health. Now, with Ebola threatening our population, the truth is out.”

In “I’m a Hazmat-Trained Hospital Worker: Here’s What No One Is Telling You About Ebola,” Abby Norman explores core health system failures through the lens of Ebola. If our health care system is so dysfunctional as to be potentially outdone by Ebola, despite plentiful clean water and billions of dollars, what can be done to or within the U.S. health care system to remedy the problems? What would a healthcare system based around population health goals look like? How would population health-based programs, projects and distributions differ from what’s in place today?

These questions are at the heart of the care coordination, stewardship and healthcare team proposals argued for in NPA’s new policy brief, Value and Values in Health Care. Read an excerpt of Norman’s article below and tell us what you think. Your responses to NPA blog posts help us refine our communications about important issues and influence the choice of initiatives we undertake.

We have the technology, and we certainly have the money to keep Ebola at bay. What we don’t have is communication. What we don’t have is a health care system that values preventative care. What we don’t have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don’t have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed. What we don’t have is the social culture of transparency, what we don’t have is a stopgap against mounting hysteria and hypochondria, what we don’t have is nation of health literate individuals. We don’t even have health-literate professionals. Most doctors are specialists and are well versed only in their field. Ask your orthopedist a general question about your health — see if they can comfortably answer it.

5 Responses to “What is the Value of Population Health?”

The article makes some very valuable points. At the heart of things, a “healthcare system” is a system (an organized, coordinated entity) that cares about health.

We don’t have that. We have a system focused on episodic acute care built upon an under-resourced foundation of primary care.

To make everyone’s health better (and reduce costs, and improve outcomes, and to maximize our workforce, etc.), we need to refocus on primary care–meaning that workforce, delivery and payment reform, etc. are absolutely essential.

One might alternately imagine that to have a health care system is to have system focused on the delivery of voluminous and/or high quality health care. This may or may not have much to do with the production of health, as we know.

I mention this only to point out how important our language is when we talk about these issues in the US. For too long we’ve imagined health and health care to be synonymous when in fact one is a means and one is an end. Health care is critically important to achieving population health but we know it is not the only way. And so long as we continue to insist that greater investment in health care will yield greater health, we’ll continue to wrestle with this question of “how do we get so little and spend so much?”

Mark talks about our non-system, and the need for organized, coordinated care. That’s true not only at the local level but also at the regional and national level. that’s what public health preparedness is all about. Our focus on ‘autonomy’ – of individual providers, of hospitals, of states, of specialties – clearly undoes us in situations that call for a standardized, coordinated, evidence based approach. Crazy.

I am not sure that the Ebola outbreak and preventative health care are that closely related. The outbreak in the U.S. was actually fairly well contained. The information messaging and the media outcry was not great. The response might have been “slightly” delayed, but there were only 3 confirmed new cases in the US for a disease that most health care providers have never diagnosed of treated. That seems to me to be a fairly successful response and control effort, and in some ways an effective prevention strategy

On the other hand, I do agree with the author that our health system does not value preventative care. Most individual providers that I know of value preventative care, communication, and symbiotic relationships to improve health. Yet, for some reason there is a breakdown between the individual provider’s values and the value of the system.

Going back to the question: the value of population health might be hard to define in dollar amounts but we know that the return on investment is high. Both the auto-safety initiative of the last several decades and the more recent smoking cessation initiative has shown large returns in cost, quality of life, and longevity.

The value of population health is to respect the importance of eliminating health disparities. To acknowledge the extreme importance of the social determinants of health, to exit our silos and work for our communities. To recognize that in the same manner that we immunize to achieve “herd immunity” we ought to practice healthcare in a dual fashion; listen to our patients as individuals and acknowledge the value “big data” gives us to address “The COMMON GOOD”.